Organization Name: | NITA J CHILDERS |
NPI Number: | 1518105311 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARILYN HODGE (PROVIDER REPRESENTATIVE) |
Mailing Address: | 1100 Stone Rd Suite 102 Kilgore |
State: | TX US |
Postal Code: | 756625482 |
Phone Number: | 9039847000 |
Fax Number: | 9039847001 |
NPI Enumeration Date: | 02/02/2009 |
NPI Last Update Date: | 06/02/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |